This week I’m finishing up my psychiatry rotation. I’m sure I won’t ever have another experience like this where I get to meet patients and physicians who are both so disorganized that I can rarely tell the difference between the two. Before I tell my last story, I just wanted to share with you what one of my attendings said today. As he was filling out my evaluation he noted, “I’m giving you the highest grade I’ve ever given to a student before. You are very talented and I would love to see you go into psychiatry.” He gave me a B+.

Now on to the story:

I had a 30-year-old, 400 pound schizophrenic woman come into the emergency department seeking a medication refill. She is very well known to the hospital as she frequently visits for a variety of complaints. She’s extremely abusive toward staff and has been committed on multiple occasions for violent behavior towards others. She also has a very unique behavior when trying to get the attention of others. The last time she was in the emergency department, the psychiatrist said something to her that she didn’t want to hear. She responded by defecating on the floor. Supposedly, she became so famous after this incident that no one in the psychiatry department wants to deal with her.

When I went to interview her, I wanted to prevent any bad behavior from occurring this time. I decided to talk to her outside. If she was going to pop a squat, at least I could just hose off the sidewalk. For a moment I was tempted to interview her while making her stand in the flower garden. I figure that if life gives you lemons, you should make fertilizer.

She was doing very well with the interview. She was telling me that she no longer heard voices, no one was after her, and her thoughts seem pretty organized. Then I asked her if anyone was jealous of her. She threw up her hand and replied, “They’re all jealous of me!” When I asked her who, she started pointing at every woman outside of the hospital saying, “She’s jealous of me! She’s jealous of me! She’s jealous of me!”

I asked her what she had that these other women wanted. She replied, “They want my SEXY body!”

anonymoussaid,

konnekasaid,

konnekasaid,

I love your sense of humor. It is apparent that you showed compassion towards your patient and kindness, yet she really needed some assistance. Perhaps, however, Haldol was not the answer, but something that would not increase her psychosis. Did you ever think about prescribing her something which would not contribute to her obesity? Haldol is a pretty serious med, and although it is a cute story– there is also the issue that you could have prescribed her a less dangerous med. Some people do think that being obese is, indeed, desirable, and this doesn’t necessarily merit the most extreme anti-psychotic med….Also, in prescribing, please consider that Haldol would make this women more obese when other meds would probably work just as well. Why would you want to do this to her?